Tag: statistics

Global Spine J. 2022 Feb 8:21925682211053593. doi: 10.1177/21925682211053593. Online ahead of print.

ABSTRACT

STUDY DESIGN: Level III retrospective database study.

OBJECTIVES: The purpose of this study is to determine if machine learning algorithms are effective in predicting unplanned intubation following anterior cervical discectomy and fusion (ACDF).

METHODS: The National Surgical Quality Initiative Program (NSQIP) was queried to select patients who had undergone ACDF. Machine learning analysis was conducted in Python and multivariate regression analysis was conducted in R. C-Statistics area under the curve (AUC) and prediction accuracy were used to measure the classifier’s effectiveness in distinguishing cases.

RESULTS: In total, 54 502 patients met the study criteria. Of these patients, .51% underwent an unplanned re-intubation. Machine learning algorithms accurately classified between 72%-100% of the test cases with AUC values of between .52-.77. Multivariable regression indicated that the number of levels fused, male sex, COPD, American Society of Anesthesiologists (ASA) > 2, increased operating time, Age > 65, pre-operative weight loss, dialysis, and disseminated cancer were associated with increased risk of unplanned intubation.

CONCLUSIONS: The models presented here achieved high accuracy in predicting risk factors for re-intubation following ACDF surgery. Machine learning analysis may be useful in identifying patients who are at a higher risk of unplanned post-operative re-intubation and their treatment plans can be modified to prophylactically prevent respiratory compromise and consequently unplanned re-intubation.

PMID:35132907 | DOI:10.1177/21925682211053593

Hand (N Y). 2022 Feb 8:15589447211073829. doi: 10.1177/15589447211073829. Online ahead of print.

ABSTRACT

BACKGROUND: The purpose of this study was to determine the occurrence of patients undergoing primary trigger finger release (TFR) that underwent ulnar superficialis slip resection (USSR) for decompression and to determine which digit was most commonly affected.

METHODS: A retrospective chart review was conducted of all cases of open TFR performed by a single surgeon. The following data were obtained: age, sex, laterality, affected digit, and consideration for USSR. All patients failed nonoperative treatment of at least 1 steroid injection. The occurrence of patients who underwent TFR and USSR and which digit(s) most commonly underwent USSR were determined. The average patient age that underwent USSR, frequency by sex, and relative occurrence of USSR in each digit were computed. Statistical calculations were conducted using χ² analysis (P < .05).

RESULTS: A total of 911 primary open TFRs were performed in 631 patients over a 16-year period. A total of 20 TFRs in 20 patients underwent USSR (2.2%). The long finger was the most commonly affected digit (40%) that required simple decompression. Within all USSR cases, the long finger was the most commonly affected digit. The index finger was the second most affected (30%), and there were no cases in the small finger.

CONCLUSIONS: This study determined the occurrence of primary TFR cases that underwent USSR, with the long finger being the most commonly affected digit. Surgeons may consider this additional procedure to perform a larger decompression than simple A1 pulley release alone.

PMID:35132886 | DOI:10.1177/15589447211073829

J Oncol Pharm Pract. 2022 Feb 8:10781552221078934. doi: 10.1177/10781552221078934. Online ahead of print.

ABSTRACT

OBJECTIVE: The study aims to examine the toxicity profile, pattern of adverse drug reactions (ADRs) and drug-drug interactions (DDIs) in geriatric cancer patients receiving metronomic chemotherapy.

PATIENTS AND METHODS: Patients were followed after each cycle till 12 weeks. Haematological parameters such as complete blood count, liver function test and renal function test were recorded from the baseline to the final visit. The Common Terminology Criteria for Adverse Events (CTCAE) scale was used to characterise the toxicity profile. ADRs that the patients had were documented and assessed for its causality, severity and preventability. The Lexicomp drug interaction checker was used to grade DDIs.

RESULTS: Of 129 patients, according to CTCAE grading, haemoglobin indicated grade 1 toxicity, while other haematological parameters revealed no toxicity. Although there was a statistically significant difference in ALT, alkaline phosphate, serum creatinine and potassium (p < 0.05), it was not clinically significant. A total of 226 ADRs were documented. Anaemia was the most frequently occurred ADR (14%) and Capecitabine caused the highest number of ADRs. Assessments of causality showed that the majority of cases are “possible” (63%). In evaluating the severity of ADRs, 99% ADRs were “mild” and 61% of ADRs were “probably” preventable. Upon assessing the DDIs, 82% of the prescriptions had “no known interaction”.

CONCLUSION: Metronomic chemotherapy in geriatric cancer patients exhibited grade 1 toxicity for haemoglobin. Anemia was the most common ADRs. The majority of cases were “possible” in causality, “mild” in severity, and “probably” preventable. The majority of the prescriptions have no known DDIs.

PMID:35132888 | DOI:10.1177/10781552221078934

J Endourol. 2022 Feb 8. doi: 10.1089/end.2021.0644. Online ahead of print.

ABSTRACT

PURPOSE: Robotic partial nephrectomies by their nature are associated with renal volume loss. Our goal from this study is to examine renal volume loss over time post partial nephrectomy.

MATERIALS AND METHODS: Fifty patients were followed for 1-year post robotic partial nephrectomy with two-layer renorrhaphy and the sliding clip technique. This was done with a preoperative computed tomography (CT) scan to assess renal mass and location. Post robotic partial nephrectomy patients were imaged at time points 3-days, 6-months, and 12-months.

RESULTS: Patient demographics were 82% male with a median (IQR) age of 57 (45-67) and all were of Japanese descent. The medians (IQR) for warm ischemia time: 18 minutes (14-22), total operative time: 181.5 minutes (169.3-218.5), and estimated blood loss: 20 mL (10-50). The tumor characteristics had a median (IQR) diameter of 2.8 cm (2.5-3.4) with a RENAL score of 7 (6-8). The renal CT volumes showed median (IQR) volume losses at 3-days: -1% (-7.1, 1.8), 6-months: -15.3% (-20.6, -11.2), and 12-months: -16.3% (-19.0, -12.8). Significance was seen at the 3-days to 6-months comparison for volume loss (p<0.0001). Mean (SD) eGFR losses were as follows: at discharge 0.5% (12.9), 1-month -6.4% (11.8), 6-months -4.6% (9.8), and 12-months -3.6% (11.9). Statistical analysis showed significance for GFR loss at the comparison between discharge to 1-month and 6-months (p=0.01, p=0.04).

CONCLUSION: The initial volume loss seen post-surgery from resected healthy tissue was not significant and only became relevant at longer time points suggesting that loss could be from atrophy. Volume loss over time supports the hypothesis that suture renorrhaphy is a primary cause of volume loss when warm ischemia time is <25minutes.

PMID:35132882 | DOI:10.1089/end.2021.0644

J Am Heart Assoc. 2022 Feb 8:e022232. doi: 10.1161/JAHA.121.022232. Online ahead of print.

ABSTRACT

Background While peripheral artery disease (PAD) is associated with increased cardiovascular morbidity with mortality remaining high and challenging to predict, accurate understanding of serial PAD-specific health status around the time of diagnosis may prognosticate long-term mortality risk. Methods and Results Patients with new or worsening PAD symptoms enrolled in the PORTRAIT Registry across 10 US sites from 2011 to 2015 were included. Health status was assessed by the Peripheral Artery Questionnaire (PAQ) Summary score at baseline, 3-month, and change from baseline to 3-month follow-up. Kaplan-Meier using 3-month landmark and hierarchical Cox regression models were constructed to assess the association of the PAQ with 5-year all-cause mortality. Of the 711 patients (mean age 68.8±9.6 years, 40.9% female, 72.7% white; mean PAQ 47.5±22.0 and 65.9±25.0 at baseline and 3-month, respectively), 141 (19.8%) died over a median follow-up of 4.1 years. In unadjusted models, baseline (HR, 0.90 per-10-point increment; 95% CI, 0.84-0.97; P=0.008), 3-month (HR [95% CI], 0.87 [0.82-0.93]; P<0.001) and change in PAQ (HR [95% CI], 0.92 [0.85-0.99]; P=0.021) were each associated with mortality. In fully adjusted models including combination of scores, 3-month PAQ was more strongly associated with mortality than either baseline (3-month HR [95% CI], 0.85 [0.78-0.92]; P<0.001; C-statistic, 0.77) or change (3-month HR [95% CI], 0.79 [0.72-0.87]; P<0.001). Conclusions PAD-specific health status is independently associated with 5-year survival in patients with new or worsening PAD symptoms, with the most recent assessment being most prognostic. Future work is needed to better understand how this information can be used proactively to optimize care.

PMID:35132874 | DOI:10.1161/JAHA.121.022232

Cancer Commun (Lond). 2022 Feb 7. doi: 10.1002/cac2.12265. Online ahead of print.

NO ABSTRACT

PMID:35132829 | DOI:10.1002/cac2.12265

J Korean Med Sci. 2022 Feb 7;37(5):e36. doi: 10.3346/jkms.2022.37.e36.

ABSTRACT

BACKGROUND: This study aimed to assess the clinical relevance of the parsimonious Eurolung risk scoring system for predicting postoperative morbidity, mortality, and long-term survival in Korean patients with surgically resected non-small cell lung cancer.

METHODS: This retrospective analysis used the data of patients who underwent anatomical resection for non-small cell lung cancer between 2004 and 2018 at a single institution. The parsimonious aggregate Eurolung score was calculated for each patient. The Cox regression model was used to determine the ability of the Eurolung scoring system for predicting long-term outcomes.

RESULTS: Of the 7,278 patients in the study, cardiopulmonary complications and mortality occurred in 687 (9.4%) and 53 (0.7%) patients, respectively. The rate of cardiopulmonary complications and mortality gradually increased with the increase in the Eurolung risk scores (all P < 0.001). When risk scores were grouped into four categories, the Eurolung scoring system showed a stepwise deterioration of overall survival with the increase in risk scores, and this association was statistically significant (P < 0.001). Multivariate Cox analysis showed that the Eurolung scoring system, classified into four categories, was a significant prognostic factor of overall survival even after adjusting for covariates such as tumor histology and pathological stage (P < 0.001).

CONCLUSION: Stratification based on the parsimonious Eurolung scoring system showed good discriminatory ability for predicting postoperative morbidity, mortality, and long-term survival in South Korean patients with surgically resected non-small cell lung cancer. This might help clinicians to provide a detailed prognosis and decide the appropriate treatment option for high-risk patients with non-small cell lung cancer.

PMID:35132842 | DOI:10.3346/jkms.2022.37.e36

Jpn J Nurs Sci. 2022 Feb 7:e12472. doi: 10.1111/jjns.12472. Online ahead of print.

ABSTRACT

AIM: Transitional care is important for improving the quality of life of patients discharged from hospitals. Patient-reported experience measures help improve transitional care quality. Thus, this literature review aimed to identify and appraise measurement tools that assess transitional care quality from the patient’s perspective and identify its components.

METHODS: Development and validation studies were systematically searched in the PubMed and CINAHL databases. The review team appraised the methodological quality and statistical results of measurement properties using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology.

RESULTS: A total of 30 studies and seven instruments were identified. The target population was patients discharged from hospital to a home or nursing home (mean age = 52-84 years). The measurement time was before or after the discharge. The number of items in the original versions of the measures ranged from eight to 41, with short versions ranging from three to 12. The overall methodological quality of structural validity, internal consistency, and hypotheses testing was mostly “very good or adequate,” according to COSMIN criteria. However, content validity and development were mostly “inadequate or doubtful” or not reported. The main components of included measures comprised “self-care after discharge,” “providing information to the patient,” “patient engagement in the care plan,” and “dealing with patient’s concerns.”

CONCLUSION: The quality appraisal results and identified components are useful for choosing measurement tools in clinical practice and research. The Care Transitions Measure is the most widely validated measurement tool.

PMID:35132783 | DOI:10.1111/jjns.12472

Eur Eat Disord Rev. 2022 Feb 7. doi: 10.1002/erv.2888. Online ahead of print.

ABSTRACT

OBJECTIVE: Mentalisation-based treatment (MBT) aims to improve reflective functioning. There is a growing evidence base outlining positive clinical outcomes for the use of MBT in eating disorder patients with co-morbid borderline personality disorder (BPD). The use of MBT has not been studied for eating disorder patients without BPD. This pilot study is an exploratory randomised controlled trial in which outcomes from MBT are compared with standard clinical management in a cohort of patients diagnosed with an eating disorder but not BPD. The main objectives were two-fold-to explore the use of MBT as a therapeutic modality and to test the acceptability and feasibility of the protocol design.

METHOD: Thirty-two participants were randomised to receive either MBT or standard treatment during an inpatient eating disorders program. All patients enrolled in the study were diagnosed with an eating disorder but did not meet DSM-5 criteria for BPD. On admission patients were categorised as very underweight (BMI 15.0-16.4 kg/m² ), underweight (BMI 16.5-18.4 kg/m² ) or healthy weight range (BMI ≥ 18.5-24.9 kg/m² ). Upon discharge participants were further categorised as weight restored (BMI ≥ 18.5 kg/m² ) or non-weight restored (BMI < 18.5 kg/m² ). The primary outcome was the subscale score on the Reflective Functioning Questionnaire (RFQ-8). Secondary outcomes were subscale scores on the Eating Disorder Examination Questionnaire and the Depression, Anxiety and Stress Scale (DASS)-21. Participants were assessed at baseline and on discharge. Statistical significance was determined using repeated measurements analysis of variance (ANOVA).

RESULTS: Both groups experienced improvements in eating disorder symptoms and measures of psychological well-being. Participants within the MBT group exhibited greater improvements in reflective capacity as defined by the RFQ-8 however these benefits appeared to be limited to patients who achieved weight restoration at discharge. The eligibility criteria-which excluded comorbid BPD-led to challenges in recruitment which limited the power of the study analysis. As participants with a range of different eating disorder diagnoses were included this led to complexities in estimating the treatment effect within a defined cohort.

CONCLUSIONS: Although the small sample size must be noted as a limitation-the finding that weight restoration appears to be associated with improvements in reflective capacity in MBT would be worth exploring in a subsequent larger study. Modification of eligibility criteria and recruitment from a defined cohort may increase the efficiency of a future study.

PMID:35132749 | DOI:10.1002/erv.2888

Int J Lab Hematol. 2022 Feb 7. doi: 10.1111/ijlh.13805. Online ahead of print.

ABSTRACT

INTRODUCTION: Increased antiphospholipid antibodies (aPL) have been described in human immunodeficiency virus (HIV) infection. However, the association between aPL and the increased risk of thrombosis in HIV requires further clarification.

METHODS: We reviewed the medical records of 215 consecutive women with a history of thrombosis and/or obstetric complications (158 HIV-uninfected and 57 HIV-infected) between July 2017 and March 2021. Participants (n = 215) without clinical criteria manifestations for antiphospholipid syndrome were included as matched controls. Testing for lupus anticoagulant (LAC), anticardiolipin (aCL) and anti-beta2-glycoprotein1 (aβ2GP1) IgM and IgG was performed.

RESULTS: Thirty-two (10.1%) HIV-uninfected and 15 (13.2%) HIV-infected participants were positive at baseline for one of the five criteria aPL, with no statistically significant difference. The profile of the HIV-infected participants with thrombosis (n = 11) included LAC in 15.8%, aCL IgG in 3.5% and aβ2GP1 IgG in 1.8%. In contrast, the HIV-infected controls (n = 4), included aCL IgM in 1.8% and aβ2GP1 IgM in 5.3%. Only LAC was significantly associated with thrombosis (p < 0.003). On repeat testing, in a HIV-infected sub-population, 2/7 with thrombosis were positive, while 3/3 controls tested negative.

CONCLUSION: In contrast to earlier reports, the prevalence and expression of aPL in HIV-infected women with a history of thrombosis in the present study, in the era of antiretroviral therapy, were similar to HIV-uninfected women. Baseline LAC positivity was associated with a significantly increased risk for thrombosis in HIV. Future studies are recommended to explore additional coagulation abnormalities in HIV.

PMID:35132770 | DOI:10.1111/ijlh.13805